Community health worker Chandra
helping pregnant women access healthcare
Plan International Nepal's Jessica Lomelin is an Emergency Communications Specialist. She visited Nepal in the aftermath of the earthquake and describes the difficulty pregnant women have accessing healthcare.
“My role is to support pregnant women, ensuring they have frequent check-ups and are able to have a safe delivery,” says Chandra, a female community health volunteer working in Sindhupalchowk district in Nepal.
Chandra is one of 50,000 female community health volunteers working in remote areas of the country. They focus on areas where there is limited access to health services and a shortage of doctors, auxiliary nurses and midwives. These volunteers play a crucial role in providing health and nutritional support to women and children.
Damaged health facilities
The twin earthquakes of 2015 severely impacted the health system in Nepal with 50–70 per cent of the health facilities in most districts either destroyed or damaged beyond repair.
“When women and children do not have adequate access to a local hospital or health posts, there is an increased risk of maternal and neo-natal mortality. Due to the earthquake and the monsoons, pregnant women cannot access health facilities. Women often have to travel three hours by foot just to reach the health facility,” explains KK Singh, Plan International’s Maternal, Newborn and Child Health in Emergencies Specialist.
Working in several affected districts in Nepal, Plan International is distributing clean delivery kits and newborn baby kits to female community health volunteers and training the volunteers on the importance and use of these kits, so that they can provide support before, during and after delivery.
The risk of emergency deliveries post-earthquake
“I was in my village when I helped a 22-year-old young woman give birth. She was just beginning her three-hour walk to the local health post when she started feeling labour pain. Her husband contacted me to say they needed help. When I arrived, I saw both the mother and baby laying on the ground,” explains Chandra.
“We immediately tore the mother’s sari and used it to clean the mother and baby. I brought them back to my home. I used the clean delivery kit and newborn baby kit provided by Plan International Nepal, which allowed me to safely cut the baby’s umbilical cord and show the mother how to begin breastfeeding,” explains Chandra.
Maternal mortality: a dire reality
“Delivery and childbirth has become a very risky scenario for women and children living in earthquake-affected areas. Without access to health centres to facilitate adequate deliveries, mothers are dying as a result of haemorrhaging and infection. Already, maternal mortality and neo-natal mortality is high in Nepal, particularly compared to the rest of the Asia region,” says Singh.
Despite progress made since 2001 to reduce maternal mortality by 47 per cent in Nepal, access to maternal and newborn care was a challenge even prior to the earthquakes. With just one centralised health facility based in each village development committee, access to health services was already a challenging feat.
“The government may encourage women to visit the centralised health facilities for their services and check-ups. However, we recognise the struggle and challenge that the journey may bring, so instead we focus on providing those services directly to the women. In our earthquake-response districts, Plan International aims to reach every pregnant woman and newborn baby in their own home,” says Singh.
Supporting temporary health posts
Many of the remaining health posts that withstood the impact of the earthquakes are damaged and lack adequate water and sanitation facilities. As the health posts are running under temporary shelter, they also lack privacy and space.
“We are not able to run the birthing centres in the way we would like. Access to clean water is limited, so the chances of water contamination is high; we struggle to wash the babies and mothers with clean, purified water,” explains a community health volunteer.
To lower the risk of infection and water-borne diseases amongst women and children, Plan International is providing water, sanitation and hygiene facilities in the temporary health posts through the provision of water tanks and temporary toilet facilities.